tag:blogger.com,1999:blog-4094472359761002646.comments2016-12-09T09:10:52.627-08:00GeriPal - Geriatrics and Palliative Care BlogEric Widerahttps://plus.google.com/117371566934715581957noreply@blogger.comBlogger3464125tag:blogger.com,1999:blog-4094472359761002646.post-61114585566500569002016-12-09T09:10:52.627-08:002016-12-09T09:10:52.627-08:00The problem largely is that these patients were al...The problem largely is that these patients were all going to die soon (albeit time span here could be a wide range) If you enter the death trajectory with a benzo or haldol or risperdal can u really then,say that these,drugs sped up the death curve. Its not like the placebo folks had a great time either. Severe agitation in dementia remains a unsolved Gordian knot. I have had some great results w haldol and some where the next step was versed sedation unfortunately. I cannot ignore the significant good results. And yet have to acknowledge the worse ones.PaoBhangrahttp://www.blogger.com/profile/05373317692917847682noreply@blogger.comtag:blogger.com,1999:blog-4094472359761002646.post-34154158962511000902016-12-06T16:54:06.710-08:002016-12-06T16:54:06.710-08:00Just listened. Love the new podcasts. Fun to hea...Just listened. Love the new podcasts. Fun to hear a bunch of my favorite people talk about this work. Angelo is a leader and this book is excellent!<br /><br />aside: not all narratives are biasing: big difference between process narratives and outcome narratives - wonky discussion offline for those interested. :-)<br /><br />Dan Matlockhttp://www.blogger.com/profile/14387683210378586450noreply@blogger.comtag:blogger.com,1999:blog-4094472359761002646.post-3985394712528551032016-12-06T14:14:05.838-08:002016-12-06T14:14:05.838-08:00Attempted to have a conversation about this with a...Attempted to have a conversation about this with a LTC DPAHC and her (somewhat ironic) response was, &quot;this doesn&#39;t apply to my FATHER.&quot; The irony being that for years, we have generalized research from younger population and predominantly male populations to more gender and age diverse populations. At the end of the day, I wasn&#39;t willing to go to the mat on the issue, but I still wonder what is in those capsules Dad is taking...<br /><br />And for the record, I like fresh cranberries, mixed with orange zest, a bit of sugar (or splenda for the sugar challenged) boiled with water until they burst. Use the recipe on the back of the bag. Beats canned every time. Helen Chen, MDnoreply@blogger.comtag:blogger.com,1999:blog-4094472359761002646.post-73945934844689978022016-12-01T02:08:47.382-08:002016-12-01T02:08:47.382-08:00We are working at team for making all subject rela...We are working at team for making all subject related writing papers and immediate writing papers to the students. The exchange of information is possible in our writing company. The research topic are more possible in our writing serviceessay writing service reviewshttps://reviews.clazwork.comnoreply@blogger.comtag:blogger.com,1999:blog-4094472359761002646.post-18780545604319457672016-11-27T09:53:31.929-08:002016-11-27T09:53:31.929-08:00Seeing Dr Toby Campbell&#39;s name, I am compelled...Seeing Dr Toby Campbell&#39;s name, I am compelled (impelled?) to share the high-risk surgery decision-aid he developed along with a surgeon (Gretchen Schwarze).. perhaps helping in the &#39;earlier introduction of palliative/family meetings&#39;<br />http://www.bestendings.com/dying-in-the-operating-room-rarely-happens/kathy kastnerhttp://www.bestendings.comnoreply@blogger.comtag:blogger.com,1999:blog-4094472359761002646.post-52866858738264964972016-11-13T21:59:06.349-08:002016-11-13T21:59:06.349-08:00Great podcast. I was called to see an &quot;agitat...Great podcast. I was called to see an &quot;agitated&quot; patient with dementia in the ER the other day, just as they were giving IM haloperidol. The patient was resisting and shouted &quot;ouch!&quot; and in response someone said to them &quot;just a flu shot!&quot; That lie felt so wrong. <br /><br />Others I have told (or been part of) in the past seemed more grey, but in retrospect perhaps they were not...-Meeranoreply@blogger.comtag:blogger.com,1999:blog-4094472359761002646.post-62829539909606956642016-11-13T20:23:33.305-08:002016-11-13T20:23:33.305-08:00Thanks Paul for this post. I had not heard about ...Thanks Paul for this post. I had not heard about this important program.Alex Smithhttp://www.blogger.com/profile/14150060020743621628noreply@blogger.comtag:blogger.com,1999:blog-4094472359761002646.post-85888589034457666582016-11-13T17:20:30.751-08:002016-11-13T17:20:30.751-08:00This is such an important topic. I&#39;ve spent ma...This is such an important topic. I&#39;ve spent many years as an RN working in nursing homes, even one that had a long term ventilator unit. I feel that what is so needed is education for nurses on how to talk to patients and their families about end of life and then let nurses discuss palliative care. Nurses in nursing homes develop relationships with patients and their families and would be an effective vehicle for these discussions. Palliative care isn&#39;t the focus of care for nursing home patients and for many of them it would be of great benefit. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4094472359761002646.post-29895126307730878282016-11-01T04:36:54.122-07:002016-11-01T04:36:54.122-07:00I very much applaud the blog and the focusing of t...I very much applaud the blog and the focusing of the accessibility of advance directives for ED physicians. So let&#39;s ask the question, what happens when the documents are actually present? The answer is risk to patient safety in the form of both &quot;over&quot; &amp; &quot;under&quot; Resuscitation.<br /><br />The TRIAD series has shown this in 8 independent and unfunded studies.<br />We need to focus on the quality of discussions and the right documents for patients.<br /><br />This whole process requires a name change to Emergency &amp; EOL planning. It also requires a non biased quality oversight process.<br /><br />There is one think that is certain, documents create confusion and translate into risk to patient safety.<br />Ferdinando Mirarchihttp://www.blogger.com/profile/12100284620352481921noreply@blogger.comtag:blogger.com,1999:blog-4094472359761002646.post-27018672760193436532016-10-31T10:47:25.740-07:002016-10-31T10:47:25.740-07:00And who is providing most of the care at home? Pro...And who is providing most of the care at home? Probably unpaid family caregivers. Yet they are not mentioned as needing training and support for a grueling(and maybe rewarding) responsibility. Are the costs to them calculated in terms of mental and physical health, lost income, extra bills? <br /> Carolhttp://www.blogger.com/profile/10751505017620616093noreply@blogger.comtag:blogger.com,1999:blog-4094472359761002646.post-71275691543294963342016-10-21T23:37:07.466-07:002016-10-21T23:37:07.466-07:00Very good. you are the winner. Do not forget updat...Very good. you are the winner. Do not forget update new information regularly. thank ! <a href="http://fnafsisterlocation.com" rel="nofollow">fnaf sister location</a> Nguyen dunghttp://www.blogger.com/profile/09597720884423218112noreply@blogger.comtag:blogger.com,1999:blog-4094472359761002646.post-27974249972169909392016-10-21T03:02:39.347-07:002016-10-21T03:02:39.347-07:00Wow! This book review is amazing. I am a big book ...Wow! This book review is amazing. I am a big book lover, but your description is amazing. Thanks to you I know which book I will like and which will not. I am hoping the same coolant works from you in future as well. Besides, you may use <a href="http://www.custom-paper-writing.org" rel="nofollow">http://www.custom-paper-writing.org</a> for all new posts and feel no responsibilities.Serenahttp://www.custom-paper-writing.orgnoreply@blogger.comtag:blogger.com,1999:blog-4094472359761002646.post-71041310362357649112016-10-19T06:52:37.974-07:002016-10-19T06:52:37.974-07:00Exactly gents.
Professor Laqueur&#39;s misaligne...Exactly gents. <br /><br />Professor Laqueur&#39;s misaligned critique will only mature to maximum irony as he enters the completion phase of life himself. His perspective will likely impress a few graduate students in literature and continue to titillate its author until that time. <br /><br />For the rest of us, we are deeply appreciative of Paul and Lucy&#39;s sharing and the reflection it has brought to its readers.Michaelhttp://www.blogger.com/profile/12651898792500307357noreply@blogger.comtag:blogger.com,1999:blog-4094472359761002646.post-84664776563076422972016-10-15T04:34:13.584-07:002016-10-15T04:34:13.584-07:00Oxbridge Masters help students by offering them cu...Oxbridge Masters help students by offering them <a href="http://www.oxbridgemasters.co.uk/" rel="nofollow">custom academic writing services</a>. Aaron Waltzhttp://www.blogger.com/profile/05363765089927563691noreply@blogger.comtag:blogger.com,1999:blog-4094472359761002646.post-24068346694187441872016-10-15T04:22:49.652-07:002016-10-15T04:22:49.652-07:00Nice and Inspirational Words! write my paperNice and Inspirational Words! <a href="http://www.oxbridgemasters.co.uk/" rel="nofollow">write my paper </a>Aaron Waltzhttp://www.blogger.com/profile/05363765089927563691noreply@blogger.comtag:blogger.com,1999:blog-4094472359761002646.post-85835796306828464542016-10-12T16:24:49.566-07:002016-10-12T16:24:49.566-07:00Great conversation, should be compulsory listening...Great conversation, should be compulsory listening for hospital execs and many clinicians sadly. 6Pack study has challenged standard hospital practices - interventions are not going to work if hospital care continues to restrict older people&#39;s movement and reinforce their sick role. I think it has something to do with individualising care and not blandly enforcing interventions on everyone. If interested in hospital assessments for older people and its relation to interventions to reduce adverse outcomes you may be interested in: . Andre Catricehttp://www.blogger.com/profile/11112977554634488244noreply@blogger.comtag:blogger.com,1999:blog-4094472359761002646.post-18602366965421188902016-10-12T11:58:21.196-07:002016-10-12T11:58:21.196-07:00I can&#39;t tell you how excited I am this is here...I can&#39;t tell you how excited I am this is here! Been hoping we could get more podcasts on these topics! I can&#39;t wait to listen when I drive home tonight! Christian Sinclairhttp://www.blogger.com/profile/14685043408496367587noreply@blogger.comtag:blogger.com,1999:blog-4094472359761002646.post-76148242460416243392016-10-12T05:16:44.838-07:002016-10-12T05:16:44.838-07:00Awesome job, gents!
So much &quot;assessment&quot...Awesome job, gents!<br /><br />So much &quot;assessment&quot; doesn&#39;t actually lead to anything but data overload and burnout for people.Michaelhttp://www.blogger.com/profile/12651898792500307357noreply@blogger.comtag:blogger.com,1999:blog-4094472359761002646.post-76157452694110972882016-10-05T16:46:11.129-07:002016-10-05T16:46:11.129-07:00This article is amazing and hits home.
We need edu...This article is amazing and hits home.<br />We need education in our communities and public to make aware of the quality of life that hospice and palliative care can give. People have misconceptions concerning hospice and our VA elderly and skill nursing facilities need more palliative care. The need is so great but the knowledge needs to be introduced along with ways to make this happen. I would love to be involved in making this available to our VA seniors.<br />Traci Cowanhttp://www.blogger.com/profile/09343783191633587765noreply@blogger.comtag:blogger.com,1999:blog-4094472359761002646.post-90952927922645184782016-10-04T11:44:09.348-07:002016-10-04T11:44:09.348-07:00Great question Anonymous about the VA nursing home...Great question Anonymous about the VA nursing home. One thing that the VA has led the way on is making sure that every medical center has a palliative care service. We do and we provide consults to our VA nursing home. We can definitely do more work there and there is need. <br /><br />With that said, we are also realizing that the palliative care needs of Veterans living in community nursing homes are so very great. It&#39;s something that we are trying to figure out how to deliver, so if anyone has any suggestions would love to hear them. That&#39;s one of the reasons I loved this article as it is a guidepost.Eric Widerahttp://www.blogger.com/profile/14874787918131549187noreply@blogger.comtag:blogger.com,1999:blog-4094472359761002646.post-55723738181007125132016-10-04T10:27:14.865-07:002016-10-04T10:27:14.865-07:00How often do you palliative care consults in withi...How often do you palliative care consults in within your own VA nursing home? <br /><br />I have found even where there is robust palliative care service, they often don&#39;t do many consults for veterans living within the VA Centers for Community Living. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4094472359761002646.post-68155250578266033352016-10-04T05:52:17.440-07:002016-10-04T05:52:17.440-07:00Thank you, Eric. Very nice post as always.
From ...Thank you, Eric. Very nice post as always. <br /><br />From the HPM Program Requirements:<br /><br />IV.A.3.c) Fellows should receive a long-term care experience at a skilled nursing facility, chronic care hospital, or children&#39;s rehabilitation center. (Detail)<br /><br />The intent of this requirement is to encourage and assure just such an experience for all trainees. Whether individual programs have the capacity to meet the spirit of the requirement could be open to question, but hopefully most see the value and try...Steven Radwanynoreply@blogger.comtag:blogger.com,1999:blog-4094472359761002646.post-90736794393726237242016-10-04T05:26:45.000-07:002016-10-04T05:26:45.000-07:00This population lives in the shadows for most of o...This population lives in the shadows for most of our society-present GeriPal audience, notwithstanding. This validating article once again reminds me of how desparately mismatched resources and expertise are to the incredible unmet need for the modest skills and compasssion-in-action that high quality palliative care interventions bring.<br /><br />We need development of more network capacity for palliative care services to be deployed nimbly to people with serious illness in nursing homes, specialty clinic, hospitals, and homes. The only thing that can drive the creation of that human infrastructure for caring will be favorable economics. The savings that come by investing in in the care of our fellow human beings approaching the completion of their life cannot be added to the profits of venture capitalists. Rather, they need to be reinvested in the creation of greater capacity for this valuable kindness.Michaelhttp://www.blogger.com/profile/12651898792500307357noreply@blogger.comtag:blogger.com,1999:blog-4094472359761002646.post-58418400158349561212016-10-03T11:30:24.996-07:002016-10-03T11:30:24.996-07:00We have such a model where nurse practitioners who...We have such a model where nurse practitioners who are trained in palliative care are based in skilled nursing facilities. This provides on-site close relationships between the NP and the patient/family, staff, and attending physicians. Advanced Care Planning is expected, and symptoms management is ongoing. Transition to hospice occurs in real time. The common barriers are family, who often have unrealistic expectations, and the only way to influence them is through the process of developing a trust relationship over time. It is kind, caring, cost avoiding care. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4094472359761002646.post-22600547242646347512016-09-20T09:51:56.335-07:002016-09-20T09:51:56.335-07:00Vanessa: Lovely and much needed piece. As a psychi...Vanessa: Lovely and much needed piece. As a psychiatrist who has been interested in this phenomenon for numerous years with my collaborator, Mike Germain, there are a number of questions I&#39;ll ask during the course of getting to know the individual. They explore and almost always rule out psychiatric disorders and major depression, including: do you consider yourself to have a depression? [I&#39;ll explain the criteria for depression if they are uncertain], have you been under the care of a psychologist, psychiatrist, or therapist in the past? have you ever made a suicide attempt? has anyone in your family died after making a suicide attempt? what does your family say about your intention to not initiate the dialysis?<br />While renal encephalopathy is a factor that may slow down someone&#39;s thinking, it rarely influences cognition to hinder the necessary conversation. Despite it and through the input from family, one may ascertain whether the decision is consistent with the individual&#39;s life choices. <br />I would predict that we will start conservative management clinics in our country in the near future, much the way they have been sprouting up in the UK and other Western European nations. I&#39;d be curious to hear from the GeriPal audience about existing clinics here in the U.S.?Lewis Cohenhttp://www.blogger.com/profile/02642527143280202440noreply@blogger.com